Published: 01/09/2005, Volume II5, No. 5971 Page 20

Although the three-star Two Shires Ambulance trust was already using performance measures in a relatively sophisticated way last year, then chief executive Paul Martin wanted to enhance overall performance measurement and management systems.

The trust worked with Cranfield School of Management's centre for business performance in a two-year project, funded by the Department of Health, applying Cranfield's performance prism framework and methodology in the public sector for the first time.

The prism framework consists of five inter-related perspectives:

Stakeholder satisfaction: who are our key stakeholders and what do they want and need?

Stakeholder contribution: what do we want and need from our stakeholders?

Strategies: what do we need to put in place to satisfy these two requirements?

Processes: what do we need to put in place to execute our strategies effectively and efficiently?

Capabilities: what do we need to put in place to allow us to operate our processes now and in the future?

The first stage involved interviews with key members of staff and workshops with senior managers, staff and external stakeholders. Each session identified the most important stakeholders' primary wants and needs, together with the trust's wants and needs of the same stakeholders.

Six stakeholders were categorised as having the highest importance:

accident and emergency patients;

patient transport services patients;

primary care trusts; Two Shires staff; acute trusts; and mental health trusts.

Facilitators made an assessment of what the key performancemanagement issues were likely to be in meeting the wants and needs of the stakeholders, and began to draw up a 'success map' for discussion with the executive team.

The next stage required the joint project team to brainstorm the potential measures to address the management issues identified.

These were ranked according to perceived importance.

The net result was an executive team that had bought into the concept of improving its performance-management system and could see how they and their team could contribute to its development.

Thirty measures were developed.

Seven related to key stakeholder relationships, five addressed the trust's strategic intent, 10 concerned important aspects of its operating processes and eight related to capability development.

Of the 30 measures, 10 already existed at Two Shires (although improved reporting formats were recommended for some of these), six were substantial enhancements of current attempts to measure performance and 14 were new measures - of which 11 could be implemented more or less immediately, depending on board endorsement.

Cranfield also developed a conceptual success map to illustrate the inherent complexities of the twoway stakeholder relationships for Two Shires, how it must prioritise them to adapt its future strategies and how these strategies must be translated into process improvements and capability development.

Pietro Micheli is a research student at Cranfield School of Management. A full report on the project is available from p. micheli@cranfield. ac. uk